HomeMy WebLinkAbout008-2009-04-000
veiaconsir Depanmertof Corni PRIVATE SEWAGE SYSTEM Coil St. Croix
Safety ano Bu. di^g Dwision
INSPECTION REPORT Sanitary Permit No
GENERAL INFORMATION (ATTACH TO PERMIT) Sate Plan ID No 605133
Pe-viral r-for:r•ator yoe l may ne used 'c, secordary pu•aoses'✓nracy l. s ri r4 tt;tinil 3145560
=er- t HJleer's Name City Village TC,-sN* Parcel Tax No Rick & Cynthia Unger TOWN OF EAU GALLE 008-2009-04-000
CS- fiM L cv. In50 BM elev. Bid DesCripLJn f0 O SeVionr I Cn^i Vange+Nlao l
/op z. (a$ tlL 01.28.16.571
TANK INFORMATION ELEVATION DATA n
'7YPF MANUrACTURER r CAPACITY STATION BS Ht FS ELEV.
SOOIic Benchmark
/406
1196-
i 2 L Dc~ Z -i 16Z.
Dosing Alt Bfe1
a ' C, I Ic(
AeratsA - Bldg Sewer
SUHt Inlet
TANK SETBACK INFORMATION StiHt O.,tle:
TANK TO PiL VkLL BLDG. Vent to Air make ROAD DI lrlet _
Septic I r7 - Of Bottom
x ILv IL. L~ ,r_O rf
Dcs ng HeadertMan.
Aeralioc Dist. Pipe
Hold rg Be: System i-iK-. r -
PUMP/SIPHON INFORMATION F,na Grade
~L~r rC7
Marufactuie, Demand St Cover
9 LA3~_ Gi 'l 4 7-(U
P.100ei NumOCr r_ L COQ r
~r65 %8
IUI I Li FncUCr • Oss Systen- Heal, TgFI, Ft
Force•ram Len:gl~ Die. a Gst to Yvell
SOIL ABSORPTION SYSTEM
BED!TRENCH % J(h I I Le- h - NC 0, hra,~cs q PIT DIMENWNS N:i. Of Pits I-Side Oia I.icoic De
DIMENSIONS
L
SETBACK SYSTEM TO P:L BLDG WELL LA + TREAtA LEACHING marufacnver
INFORMATION CHAMBER OR r` I
Type OI System
>!1 )<.-i UNIT 5lodel NUmoer.
DISTRIBUTION SYSTEM
Heade ar hlc r .r Ou eyo90n x dole Sze x hole SFacing Verl :C An Intake
Pip
Leri Da $p., rant,
I e'g'A -J lira _ 1 77
SOIL COVER x Pressure Systems only xx Mound Or At-Grade Systems Only
Depth :)ve" Fn,A.) (i xx De_rtr Y _ xz Seeoeu Socdetl _ :a M1LIChC}_
f:eC' "ercn Curter Ded+Tcnch edges - Top soa Ye No ves No
COMMENTS: lirclude code ciscrepencies, persons presert ae; Inspection M1 9I Inspection a2
Location: lcDl hgTH AVE ~t 'I
1 1 All BPA Description = ( t vv ~V ~I ki 5 ~ ~lY ~ U d L✓
2.) Bid; sevrer longlh = ~3
L^ U
-amount of cover
Plansi Raddfl Yes No
Use offer side for for acct tional inbrmaGOn.
SBD 6110 fR YW; Date IrseF-toi s Si - ,:ert IJG
S ma. Ala; ~P~ 5f)ty-a~~8-0) ss
- -
- iralu cr la s fhvsien
rSp 2018 1'O I3uS I(> aen~lcry Pertmt \umb r(ru be t'd i:; hq Cn.i-~
5 f i,lhuon N 7U, IG2
r
L_ ----i_ - _ - Tlaw Tra,tuctiun !Jnr, bc• _ _
baftit ijy Permit A,ppftcatto 51(00 *3 Pq
n a oldance u•olh lPC 4i ( \b rs. 1dm Code 5.tum .a p .r tas LLMI a th app, + tc eaai rnenty unit
r + yair pro r u, bur Ian{ 5 xam ry p mot NW1. Al4fb -au n loam, fm mm- ,,wed POP•-I'S arc suhn WvJ rn °ro;ul ! Address (il di(li~r,e III. mailing aedre.) II
I 1 U .unoa r I S Icty an' I rnf 55101131 Sarvr n. PIIa ual in atfnn vot'nu -:dc may he 3rd h w s und' f q ~j '7 QQ yIQ
sn• nlarr c vnb the Ps e9fnlnr )n
~fditafl
Penal S
I Y-
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CK l✓~116 008- 009- ~da/-coo _
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'roprny (Tuner'<)dmhu;•. 9ddm•+ , PrSrxav Lucvnw d r' a
j State --7-7ip cod, --Ti-tune Nrmtl.cr NE'L+. NL~ S.e:m~
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J9 T lcuc'c rn,.
✓D6DU/LLE 1- _ _ SYO.78 ' 715-
_ &08-5$aI I q ~g r ~,.~.,•L,?'
1)vpc of uuUAmyn axk all Thal appl y'1
.ur _Pa ulyUS Nmuhcrof Bt4b5.e>ma Jubdr,isron Name
I 1\7J/ I W I
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6K RrsIJ ~ ~r jq/ EAOQ4S _ _
u •lic(.amn tninl-Dc c:ihc Csa - I;
hn:c Our 3 Dc>cnlro hs.' / ~~~OOOVOO~~~i CJA" Numbtt G-wragot
f -
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of Av -
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I I 1 - -or. La.J- r dr 0115. hn] n 1111 \ r'oalpk4 10 Ref nppSte ohl<) ~~~p~ - - -
1c^ s, t. c: LK ac.nu :l ;)-.:r.r Ttcamrs ullun;ine LuA Ksp+. ccmcn!r)nt) ~UUtct hF+rGl union to Lxisun).$Sfcmlccplmn)
Lat Prc•nnv; I' nn t Number ur><I D:ro IssacJ
H i P n 5 ❑ -n:.[ It i- ❑ mnJc i I Rod a ~'-I hn( Tr-nn.,. N_a
RC.> i I , r Hm 11110+ _ -
l. r e-I
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I\ 7.pc of P<I\\'I5 SwkwC olnponrnVDevice !t heel all shat apply)
-1 Cnn-P.uaurneA In-(inuud 1:P.I1.1I•.d In-f;M11af ❑:\'.-L J .r• d ?J as orwilWale. 1(nurd-2)',. 'ruitab'c>uiI
' loldm • Taul 1J o[b Dr p r .J Cu, tom w (ccpl u l 1~ swt r nt -s
ihyetsd 111 \n.aln6n,U Ullm, _ _ 61 ~-~Z_ ~r - _ _1 - _ K- _/f
i) iu 1140 (5v,i) -Ds.ign 4111 Apphs uou so'ef, 7)iap:ryt e iCquirt u I Uulti yr Ar.v f, -a1~5~a ~uian GaJ 1'•owt
ySo __io 6rAf ! 5so /iZrS__- yso r "-9a,a'
_r
XT r and In1'n npaaty rr. Total I - 01 \lanulAcaurc t r
Callrns 1 all 115 L. nns Y
l L I
f Ceti Tuuk a .0115 rang. 1 . I_/ - i ! I_ IO J V' N L L
_ 00~_- I OCO / _l._~_ /6 Ea .JCRe'rcf; ✓ I
\11. Responabohh Sfatemenl-1, the undempt-d u a 1>p.n rbrUf 'or 111111 Urn ol'l15< PO\slti>ho umr the aff4ched plane.
I, wbc+'.1 nn I ri is r , Plun I ,,r .m - T SIPrl8M5 Numlx•r Ntnmtn 19wu Nurnhcr
aN✓ ~fEt i<S- yYi Z~ a73 J3 %4
"umbc n~.!alr<.a tSvct. C'rtv. SIca Zlp Cb,c.
41,72S 45-, A~,?W S
ifnlUepmtSnent Use oul)
r•.. I 1 r ~ ~ IIaL Ip I j r °u Sn_,
iX. Cnntlrt c oxnf~T Om I~isappl us vl -
1 ep1 ar a SIa o a>r4 r!J L.MAd✓i'F's`rfb 'fti Q /
ohper::¢~~ cell cwst'ell toe sa_k'vs' n•t h)- r
x per marayomen! plzn n, o ndrl by plumoe:. r A per .
2 M "I rlt3,ll'4^.',en:5 muut ee.- art:ir e? /
,ir
r per oXkrbN co& / : dir Y'M.
a+:orb e.. .mgnn. plan. nn tlr >yarnn m.i a44mG to tM l m,nn W, nn papa, wl le,. fl.. 3 U2 a I114`,111111ube
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DIVISION OF INDUS I RY SCRVICES
F,, 1-54' N RANCH RD
HAYWARD WI 54g4?4,,462
_ p Conact Through Relay
P S 9ttp::tdsps wi.goviprcgrams1ric Lstryy se•vices
l NW.V w1sconsin. COV
'.'if N~ Scott Walker, Governor
Laura Gutierrez, Secretary
August 1-1, '018
CI )S I ID No. :131346 ITTAV: {'O11'/:C fnaprclor
JOAN I IFRRFR I PUKE ZONING OFFICI.
PFLKV PLUMBING ST CROIX COUNTY SPIA
\6298 ST IFWY 25 1101 CARMICHALL RD
Dl RAND WI 54716 II(I)SON WI 54016-7-08
CONDITIONAL APPROVAL -
PLAN APPROVAL EXPIRES: 0814'20211 Identification Numbers
~-lransaction ID No. 314iS60
Site II) No. 811743 _
STI F.:
Rick I I ,er Please refer to both idemifir,tlion numbers,
'696 59TH Ave ahovc, in all corres tondence with the a,--'ell
Town of* Fau Galle
St Croix County
NEI4. NEI 4. S1. 1'.18N, R16W
FOR:
Object type: POWTS Component Manua, Rc ul;aed Object ID Nu 1791i07
Maintenance required; 450 GPD I Iuw rate; Svs;ent(s): LZ_flow Mound Component Manual. (R. ~ 12), Pressure
Distribution Component Manual - Ver. 2.0. SRD-Ill?06-P tN.01 01, R. 1012); F.fliucnt Filter
I by tiuomiual described above has been reviewed for conformance with applicable R isconsin Administraliue Codcs ` - -
and Wisconsin Statutes. 'I he submittal has been CONDIT IMALLY APPROVED. Chic system is to be constructed o"'"
;:nJ located in accordance with the enclosal approved plan. and with any component manual(s) referenced above. APP' RO
the owner, as dclined in chapter 10 1.01(10), Wisconsin Statutes, is responsible fix compliance witb.f(e F SAFETY AND PR
requirements. DIVISION OF 1NDU
A cope of the approved plans, specifications and this letter shall be on-cite during consmiction Bnd open to
inspection by amhorircd representatives of the Department, which stay include local inspector All permits i
required by the stale or the local municipality shall be obtained prior to commcneenrent of
construction! installation! operation.
In,r ntin, this approval th Division of IndusuA~ Services reserves the right to require changes br addilio I
conditions arise making them ncccssarv for code compliance. As pcr stale slats 101.1'('_ 1, nolhm, in this review $ RR $
shall relieve the designer of the responsibility for desinnine a slum buildinv. structure, or compupenl.
Inquiries concerning this correspondence may be tirade to me at the telephone number listed below, or at the address
on this letterhead.
The above lell addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation, operation or maintenance of the PO\V'1 S.
Sipe-ercly~ Fee Require( S 250.00
111 Fee Received $ 250.00
i ( l Halance Due $ 0.00
I:;isb•i A ~ j1or
Wastewater Specialist. Divisicx. oflmiuslrv Services W'iSMARTcodc: 7633
t? 15)634-3481 . Mon-fi-i, 8:00 a.m. - 4:30 p.m.
cdwin.tavion itvi.gm -
,>age 1 m'9
Dr " ,stc~.~.atcr Trcatmcnt System
.ndcx and'Vitle Page E`VE~
r?FCi
I':-_,;cctNamc. a1v zye.t-_3 -44 /iouu0 /-041TS Cn/ErJ~ atSU~s
SPRY SERVICES
ci\\ncrsName: If
"
- - - - - - ---ii'i``.-~:
oncr,:Addre.., aG94 _ f9_~r ueS_
G~ooou/LLFt Jr 5,9102'?
7/,~ 8oe - S8a/
i.:nicipalky: 'I-o_ovn, ViF oge, Git o.' EA~L7/LLE_ _
~nun): ...ST. (~AOiX
I..,t Vumbcr: _ Block Number. CSM Number:
`1~11nliyision Namc Q/,~E EA4aw5 ,S9 r2
:.I). Number: d OB- 0'00 9 ^ o y- Doo
"ace I Index and'i itle page ED
PaLe Z Plot Plan ESSIONAL SERVICES
Pagc i Cross-Scctiuu & Plan View of Mound TRY SERVICES
Page 4 Pipe Lateral Layout
Page 5 Septic Tank / Pump Clamber Cross-Section & Specifications
Paue 6 Pump Performance Information
ON N
Page 7 Pt_)4~-t S Owner's Manual P. Nfanayemcnt Plan
r
Palte S POWTS 0\yilc' nr.~
Page 9 f=ilter lnfonu;tiinn
Name ofDcsilncr: .TN-,
Stgnaturc: /n~-n ei Z Date:
Designed-pursuant to the ti)liowin_ N AY_1S Component Manual and DSPS ti i - 3
-EZ Flow Mound Component Mami'd Sian g'ar' "W" PT CI.!'IL-7 '1 )1 N1 I 9RI)-10706-P(n`.)1101 )..I'trstuc;) iir,mi nrtr. r i 1- 1-mi -.t!
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Page 01 C!
COMBINATION SEPTIC/DOSE TANK CROSS-SECTION
AOANG NOT 1 O SGAI Fii
F id11L MANHOLE RISER & r;OVER
_ SPS 38425 d;da
frl i. P e -
kxkiny devpe d waminy IanM E Aend I
Inhnla{sl cr prcper drainage) mannole nun as nocecaary.)
4- Min Son 40 PVC Tank Vent
FI FCTRICAL located 12 aem„ gmdr a 24
4' M. Sch 40 PVC Tank Vent JUNCTION BOX above
BUILDING SEWER located 12-above grade or 24' J
! (Per SPS 382.30(11)) above Regional Flood Elevator, fcemoer with SPS 318
aM NFC 300)
( G(1 R"=
i VA •.i
i - c 12-
1 coVel ( I
8
J NLNKILE
_J II
1 (t 09'TCM OH NI FT 1ti1,61 Nwatgn)-~_~._3 " f~T,«n- nr I`- 1 II 1
L ':Z7
' i ~ VEST ~ A
rl rn D
Yr' 4 OIL rrR _J C
I I a, r~
- [ -qpc ergov~ LM, Size
4
Inr Wdal =4 F•YL[l, a om B
npprre4 a:Owm r
I 1 A fr.:.
7:".nl11.4UNI OF 3-OF SUITABLE BEDDING BENEATH TANK 3 MAXIMUM BURY ULP I H OF .X,
Anrnoring of tank n:ay be required per SPS 383 431
-an-:IV!en:itss[urer- /ESe,c ~odc~ErE Daily Wastewater Flow (DWi
S-p,iciPunnp Size. /Boo /G cid_ _---gallons Number of daily doses. 53 (4 V%
A am Manufacturer: ~yLr-4A5 9- Rx - /L3 r
P.4udel Number. YANK 19"eAr- / Force main volume. gatft= /,S5 cal
S:, Ach Type: /Vrz114 wzvc x4 Actual dose volume: , r , , - /S
(total tlose volumie --ev.r. . r. -
`,LmufaCturer 246zz E.t
P~lcrel Number- DOSE TANK CAPACITIES:
Reserve above alarm 1~ ca l I D'
.1 F um G s,--arge Rate- o?S.O$ - --GpM Alarnl float above on float a ir. = 33. S gat (C;
On/Off float measurement 1/10 in - oo. G gal (B i
Verl::al lift (pump off to lateral invert).. ft Off above tank bottom
g;,l iAi
System head (distal pressure „?.S x 1.3 ft): 3.3 It
95 ft Force main, x1100 friction factor- y It DOSE TANK DIMENSIONS
Filter friction loss If Length /.SD in Aidtr in
Total Dvnamic Head f rDH'1. /7. G ft C_ILet height 3C r Callc^.r;P nnh
I~t L ~
k
TGT,'1L C`rNld,I1c HEADriLO'"' %~G 9
°UtdF PI ?FOHptAM1Ce.::.;F::1E uERMINUTE OF
EFFLUENT AND DENIATERING
i I
I4. 'J)
MODEL 151 152 153
t- -
i1e;e6 et _-tr,. G, l:xr ;al. tJen _
I Ilr I rNf pe• 2t Tf 291
? n4S 170 f 61 r
y
a 4.. .52
64 r~) to
197
75 1" 67 N -29 t ISO
1 V 91 23 !i 33 125 _
22 95
VI ~ 121 - - 1 11 42- -
:/I~, / _ Sh aa'noao 9Cn r5 trl 38i1t Gm. ii9f13Mn)-
v 0145/.61
r Model 151 Models 1521153
m a2 w Iw
1
1z1 cam. are
lo~
r `~1~.: srv l~ ~ ,,a
ElccVica: altemaiors, +or dc(ilcr, syedems. arc aa:arablc` aril
supplied with an alarm.
s r;at:e level control svnlches are available for controlling
wrole phase systems. _
Double piogyback variable leve'. float switches are available
!or variable Avel long and short cycle avdrols
- Sealed Qvlk-Box aaailaCVC for outdoor installations. See L
Ffv11420 - - r Ff -1
-Over'30`F,54'ClspK!lgar~F.livlre4jirw1 N7P.
15151521153 MODELS Cmdrol idecl on _
Model Yobs-Ph Mode Amps Simpsx Duplex
V151 -t' 1 GA 1 2or3
8N151 115 • A J10 CC IrcWYG 2w3 w
E151 23C 1 Non 32 1 2or3
eels 230 1 1 hilt, 3.2 ' Irawe9 2a3 Easy assembly"
N152 115 1 1 Nat, 85 1 _ 200 4
nN152 111 1 Ail, 6 Irowee 2or3 ~3 \ (Wrgx6 pv,ISrVr core
h-. - nWYO'.
H 23f Nm a?- I-_.. 2a3 vvt\
BERG 234' t A.m 43 Inkedec 2u3
Ni 3 IIS t lm rr5---- 1 2or3
aN 53 115 wu r,--_. snob'- 2w3
rt.u 230 1 `ton 51" 1 7w3
eh 53 233 1 _o _noi to ._2of 3
1. Single piggyozck variable level float watch or double niggyDack vartaDle revel
float switch. Refer to FI,10477. Reduces potential clogging by debars
2. See EhIU712 lot correct model of Fterldra AI!rsnamr E-Pak . Replaces rocks a Micks under the pump.
haade of duraofe, noncorrosive ABS.
3. Vawbie level ro lml 9w1o110-0743 used as a conlr i actr~awi, sper-i'y do~ex
Raises pump 1" aH butttr,l of basin.
131 or {S,) float sysVrn. r: cmdes the aWily to raise intake by adding sections c` 1VT
a 2' PVC pining.
(ri_cnuTr_oN_ Attaches securely to pump.
A~corrnudates sump, dew•alenvig and effluent appicabons.
NOTE: Make sure float is free from obstruction.
For unusual cund,tiurs a reserve sofety 'aclrK Is engineered into the design of every Zoeller pump
0 Copyright 2008 Zoeller Co. All rights reserved
9
('U 1v %ti L)N`s " MANil;11. N't) MAN 1,G& NIEN'I pl_. N
FILE INFORMATION SYSTEM SPECIFIC TIONS
Out
%cK uA14 Eq. _ I Ni n" Tank r_-p I - loon `31 ri ant
DI SICK P^M"111. I ( ICS --_JJl ticpu< Ter„ Mat a euurei j- G/[ESEr(__~o.r)ee i \A
. n b is l r n.r. (100od'bedro0 m) I~--_ lfll u,n, 1 titer Manufacturer 7- SA
Ar, )bc of l nu t crcia !Jolts I E(flutni fillur bride! ~L-/O _ '7 Vn
-4nn aced tin tvua~e) - Pump Tlnk Capacity. G09 t tl O NA
.36o t,alldnY _ _ _
Flow I D\l' ) Pump +nA \4anutacturcr
"limited x 1.5 ~J/ES E.c Co.ocit 71 NA
f)i n • ~7/JO al•da .
y Pump p iluiacturct ZOELCE4 J NAi
Soli \nplicu urn Bate _7
I-- - _ Z tl'•da\ .17 i - Pw)p\lodcl _j._ /.3'/ l,l tucnl:T'llut.nt Ouatitr 113 NAi ~NJonthly 1 Brag, lifelre tnncnt Lmit (9 NA) -
Fats. Oil RGi\>eiFO(i) `3(, m rl. ❑ Sun'Oravel -atc. O Peut Filter i
Biochemical 0sy,~cn ryeumod (B0D5) O Mechanical Aeration 7 Wetland
0 tr.2f1..
total Suspundcd Solids (TSS) O Dtsmfietion 7 Vthcr
' 150 mg;L Manutacmn;c Ndodel:
Prellellxi I'Muent Quabty (9 NA) Monthl7 Average Soil Absorptinn Componoit (il NA)
13icchemicnl Oxy.Len Demand i130Dsn 30 n101 , O In-ground (gravity) 0 In-ground(pressuitzed)
I )fJ Susacn,l d Solids (TSS) In oyJL 17 1t grade W Mond
i--c..i Cob ornn f rnmc," n:c rni I t0 1,1001111
C7 Dot, bnc O Ot.mr
Vertical Distaoc Tank Gott .n to Sci vitc Pad Jp
Maximull Effluent Patt"Ic Site ~lii ut h diameter I L.Horizontal Distance l ank(cl toS.ivice P<d' 9 r
Dispersal Unit N1fg_Nlodrl Number: Ez FLo~.90J~V ~UdOCES G' N4
Cnluda[imu: - -
Soil Dispersal Rnd Cap (Dispersal Unit PISA)
1)P1P - :medic=ti n Rate = Arca _R"ju,"d - LISA -.nfficneh lVidill) - _d Units or Total Length of ltcn:hisY
DESIGN CRITERIA
} f-I "I )esi",n Pressure Distribution Networks to, Sedlie Tank-Soil Absorptjon Systems" Publicaiiun 9.6 (SSWNiP Manual(
yllnvtoch Muur-d Componmi Manual" Vcriun !.7. _
Nr"LZ Fimv Mound Component Manuai" Version 8.1112007
O 13f)- 1 og5C-P (I(.1! 12) "At-Citadc Component Manual Thing Pressure Distribution" Version 2.o
7 ti 13U - 10 '05 P (N.01 Of ?"lu Ground Soil Absorption, Component Manual" Version 20
SBD- 10691-P (N'.01+0!)''Mound Component N.anual"vcasioo 2.0
j 7 SBD - 1065?-1' tR.6)99) "Drip-bnc L(Iluent Disposal Component Manna("
9,)BD - lwflh-p INI 'lJ1,01) "Pressur<Disoiindiun Ccmponeni M:mual" Vataior 2.0
7 Ut^cr:
bi'.i\TEC tNCE :NlUNI'I'ORlNG SCIIFDOLE MAINTL\ANCF. AND MqA\.\(;EMF.NT
♦ Lvcnt Srn' ce V, qucncl-__
i :-leer duper a' li lea, iihu Ie ut our wcr l3 nlOnf is 3 r, +r 1 Otitul.. _ i~
_ ill~i~L% i i tnnp \ I ump cw.[ a l tl r:n. ini't"a[Incttt w!it At Teat o err r%m 7 monin, 7 ± yc~li. O NN
F t tin su t t ,t_; _ _ - qt Irxc w..c ev.ae_ 'l moot1,: 'IfS ye ars O NA
START U: LND OPERA FION: Fcr nc•,c cunstni,::ion. prior to using [tie POWTS ".Leek Ircaancnc laukl.<) in the p:esrnee of pau)dn
products or other chtimcals that may impede the Ueanmem proceca andior damage the dispersal cell(s) If bleb conxu[rilicrs art detected liar;
the ennamts of the tuok(O removed by a scptage scn-icumg operator pint to usr System startupslullnotoccur when soil conditions are frozen
at the infiltrative surface.
The piopeny owner a responsible foi the operation and maunrnance of the POWTS and submission o.` required rcpons. The quantity and
quality of the wastewater stream will affmi (lie pei fomiunce and longevity of your PO\VIS. The installation of water-saving appiiances and
tisrtucs along e; ill: prompt repair of leaks reduces (Ire wastewater volume. Also the brine or waste from water suftcmc , iron tcuaoval units,
•:nhel dc,V water Ireannew devices and foundation drains should he dischailicd lo the -ground sufacc whenever possible. Note; this dies not
:,"male fauedry waste, showers. dislm•ater, clc-
This syslent is designed to handle domestic soctn'th wastewater. however, die disposal of foorl baser) grease., oils, vcgetable.'riaaic pert;,
seer.., bones, and food sohds, such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should
be discharged into the system. Other nor-biodcgnadab(c items, such its baby Wipes, 1a111poro, sanitarv napkins condoms, cigarette buffs.
dental floss, and cotton scabs, should not enter file system Chemicals, such as petroleum products, paint. disinfectants, pesticides.
tan v af~; sal>1,Jv ivfainra it It._SUiar sro¢l;' I" Ilk Irv cpr,:ua imp laundry %I.,c, ing llnoughoul the week 1 Avoid Y`rJe u'atlic over
I ystem componanl> (bnyractn,-t v.l snow ovcl the diSlx.rsu) (in it in it) cause into freeze up.
I NSPEC170NS & ,MAIM ENANCE: Inspection mall be made by an individual curryomg one of the following licenses au
rrlilicitionS: Master Phnubcr. Master Plum bcr Rcstticled Srurcr, PON'-fS A4aint:nnzr, or Septagz Servicing Operator (per the ett ~.hcJ
d,imlenance Schedule). Tank inspections must include it visual in pectiun of the lank to ideality any missing or broken hnrri r,
any cracks or (oaks. measure the volume of"combined sludge and scum and check for any backup of ponding of cfi"lucnl
vnd surface and Icst Al clccuical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed opri
r,ici than 3 inches in drtnreter shall be secured with c17cciive locking devices to prevent accidental or unauthorized entry the larks
it :n the rnmhimrtl!m ol'siud ge and sewn in any tank cscccds one third (I; i) or roue of the lank volume; the entire contents of t:ir
I,K Shall be removed by a Seplage Senlcing Opemlm' and disposed of in accordance with Ch. NIL 113. Wisconsin Admin. Cod:,.
:ulic scrv:cin mechanics must be provided if vertical is `I i fecl or 4fhonzomal is >150 feet and instructions to be provided below.
i,: outlet f l terls;r sha ll be inspected and cleaned urrcntovc any' accumulated so lids accordnuy to union lacture:r'S Speer l icat ions. S, i i , l .
a Shed From The filter shall be retained in the tank. Pilfer cleaning may he necessary at more lictfucnt intervals that stated w i,,....! i, ttenalicc schedule to keep the Systea
t Operating.
Mums should be tested on a regular basis by the home owner. If an alami sounds, contact an individual licensed to service Prro.
i,, iS no. Inahly a I day reserve nrdcr regular operating erurdilions, however water should be conserved until any problems will:
- rnr are currecrcd to prevent bark-up of sewu_e into the dwclhin" or 5urlaeing.
w_ItaNDON'AWNT: N hen the POW fS fails andior is permanently liken om of service the foflowms: steps shall be taken to ensure i 1,
. e system is property and safely abandoned in compliance with Ch. SPS 333.3.31, Wisconsin Admin. Code.
All piping to tanks :lid pits shall be disconnected and the abandoned pipe openings Sealed.
'the contents of all tanks and pits shelf be removed and properly disposed of by a Septage Servicing Operator.
Af ei pumping. all tanks and pits shall he excavated and removed or their covers removed and the void space filled v.:il,
(ravel, or other inch solid marenal.
L\< A PLAN: U the POW FS fails antll canal be repaired the following measures have been, or must be liken, to I'! ..,1~
r. i , mI Icplxcmrnl syetcm:
v tie wplaccorent area has been evaluated and may be utrlizud hit the location of 'a replacement soil absorption sy a~ n.
mm~t area should tic plolecwd from disturbance and compaction and should not be infringed upon by reyuirrd 5Cib_,
il., -xcaing and preoosW Structure, hot fine, and wells. Failure to protect the replacement aca renders it unusable. Rcplaccm._ni
"I LN must comply with the "Iles In effect at the time of replacement
suitable replacement aea is not availabic due to setback andior soil limitations. Marring advances in POWTS lcchuoloee
holdin,, rank map he in>tellcd as a last result to replace the tailed POWTS -
'I -he site has not been ev;luated m ideuti'y it suitable replacencut area. Upon :Failure of ncc POW I S a soil and site evaluation nm.,
lie pcilinwed Io locale a suitable icplacentcnt area. If nu replacement area is available a holding lank may N. installed as a i:,.,i
resod to utpiace the failed POW TS
Mound and at-glade soil absorption systems may be renmstrucied in place f2,lloming ranoval of the bimoUt al the infihraliv:
surface. Reconstruclionsol such sysrcros must comply vvith the uuhes ineflcctat that tinge.
\ \R\INf_ svi"11C PITAi P, AND OIHLR TRFAIMENT -RANKS MAY CO\'1'1:1\ LFTILIL GASSES ANUOR I\SUh11C'IEN 1
\ (11, :N. DO NOT LN I6R A SIPI IC, PCNIP• OR OfHLR'fRE.ATNTENT -DANK UNDER AN N' Cf RCI A'ISIANCES. DEW;
\ ,186:51,LI.R6;SCU1-.pl':11'ERSON 6ROM IliEINIMOROI•ATANKINIA) B6:DIMCULI ORIMPOSSIBLE.
~U; T20\AL r'Ox1M r:NTS
- - LE n - _ POWTS MAINTAINER _
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S :1 1-AGE SERVICING OPERATOR (Pumpeir ? LOCAL RIEC LL.ATOR AL TH_ORIT1'
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57 . (4tOIX COUNTY
SEPTIC TANK MANTENANCF AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer _ l C 4~y L arot Cy n (GL 1Z U A0 a,-
rb_i11~. 11Syh %kv ~'('orJa~'il(L~G>u. 54G~f
Property Address ^a q, i 5 Q i Uc W 0 oa Vl ll e M- 5YO;-k
1' / f (V/miricati/o'n~requredfrornPlanning&Zoning Department fuconswctiat.)
Clty/State Wa~tilV ! (~e~UtQ.. Parcel Identification Number
___CLO~K- ~aoR- o y - Uou
I,F,GAI, DESCRtMON
Property Location Sec. Q L , T oZ N R I to W, Town of t OW CJZt_
Subdivision W 4d pute Keod"s _ Lot )011,
Certifled Survey Map # Volume /0 Paga # 5~
Warranty Deed (JO Q Volume Page #
Spec house yes Lot lines idcntifiab yes no
SYSTEM MAINTENANCE AND OWNFR CERTIFICATION
Improper use and maintenance of your septic systern could result in its premature 1'aihrro to handle wastes. Proper
r,nintcnancc co;uists ofpumpine out tlr.-- septic, tank every fhre rm, n sr, 7 i_
the system can affect the function of the septic tank as a treatment stage in die waste disposal system. Owner maintenance
responsibilities ate specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a roaster plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I) the on-site
wastewater disposal system is in proper operating condition andlor (2) after inspection and pumping (if necessary), (lie septic tank is
less than 1/3 full of sludge.
0,c, !Ie u ie![.ir r ~ na%c :e td :.i t3 a6m.e r l r_Titen- ,,11:1 r:C t' i'a'ti nre ' t,ri d.,.r sri i. w=.yos~' a,~tcm rd4~ diti
standards set forth, herch:, as sat by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
i./we certify that all statements on this form are tot to the best of my%our knowledge. 1/we amlarc the owner(s) of the.
property described above, by virtue of a warranty deed rec rded in Register of Deeds Office.
Number of bedrooms 3
2CI l
'ATURP.O~PAlrP PLI
L CANT(S) DATE
ATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
include with this application a recorded warranty deed from the Register of Deeds Office and a copy of die certified survey map if
reference is made in the •.vnr. ~r'•; :aced.
(REV. 08/05)
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^:~sor.~;ir. oepar;mentof Co:nmer;-c SOIL EVALUATION REPORT Page_ r' u: _
Division of Safety and Buildings
n axordacce w'.lh Ccmm B5. LNs. ACrn Code County Alta oil Winplete site plan on pape! not kiss than 11 1 r2 x 11 inc•Ies In S.ic- P.an mast
include. but not limited lo: vertical and WZOAlal reference point (B(d), erection and Parcel I.D.
percentslope, scale or dimensions, nosh arrow, and location and distance to neat esl road dL
Reviewe Y Date
Please print all information.
Pe•sonal.nro•mafon yDu provide map t,-,used for zunonca, purposes Ivnvacy Law, s. 15 ca rf; (1n)t
.FT;--,pcr^y Owner Property Loca5cr.
I GO-4. Lot ti,~ 1 4 V G 1r4 S T N R E (oQ W;
I Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
Stale Zip Ccce Phone Number City ❑ Village QTown Nearest Road r -4- L
Q'~Naw Construction Use: 0-_Residential / Number of bedrooms- Code derived design flow rate - GPD
Q Replacement ❑ P.:blic or commercial - Dosoibe
'
Parent malena: Flood Plain Clecal.D11 if applicaole n'
- -
.,:.•al comments - td r 1p_ 1 f. v~
7 e:n-nmendaaons. C - ! ~
C C`yttcy,I - J$' O
❑ Bormy
6autg # h'-- -t:. Depth to•eniling lactur in.
U Pit Gro„ndsu.r ,ace.„ .,ev _ Soil 'ioation Rate
3C9 Depth 1 Dominant Co or Reocx Description I -iex:u.e Structure Consistence Boundary Roots GPD114
'Eff#1 'Eff#2
;
,n. Munsel; 0,:. Sz. Coil. Cola Gr. Sc. Sh.
. , i , 1. - _ c , _ ~ - Y ,y •r -
❑
Boring Baring
i f! Depth to limiting factor - in.
_ ❑ Pit Grcunc surface elev. g Sal 'icalion Rate
i--,n. on Depth Dominant Cc,or Redox Description Texture Structure Consistence Boundary Roots •E GPDlft'E
in Munsell Ou. Sz. Curt. Color Gr. Sz. Sri, - -
in
1
> 30 1, mg:L ' Effluent #2 = BOD < 30 mg/l- and TSS < 30 mgrL
Effluent #1 = BOD > 30 < 220 mg1L and TSS
'
ST Name (Please P t Signature CST Nurtlber
.
Te:e hone Number
Hdcress Dale Evalcetion Conducted P
I 7~
-17
-~:porty Osvicer c_( V~_~~~Ji Par;;el lU#
_ Page of j
Bonne # O Boling
p11 Ground s:.dace elev. n. Cepth to umiling feclor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1fF
ui. fauns_ell Ou. Sz. Cant Cdor Gr. Sz. Sm. •Etf#1 •Eff#2
dc
- G:
r
non
O
Boring
J P't Gn:u^:7 s..rf2ca elec. rt. Copra to iniiling laelor in.
Soil ADplrat,arl Rate
.1., on De;ah Dom.narl Ccic• Redox Description Texture svucture .C:xwstence Boundary Roots GFU:fr
in. Mucsell Cu. Sz. Cont. Coloi G1. •Etf#1 'EH #2
I
I
i
Boring # ❑ Boring
❑ Pit Ground surface eiev- ft. Depm to :imning factor in.
Soil A ppLcalion Rate
-1D _ 7Deplh
Dominant Color Recox Description Texture Svuclure Consistence Boundary Roots GPDiff
fAonseli O
u. Sz. CantGr. Sz Sn. Eff#1 'Eff#2
' EfP,ucnl #1 = BOO, > 3p < [e J rugiL and TSS >3J 1,o nigA ' Effluent #2 = BODs < 30 rngil- and TSS < 30 tngrL
l.c Depuroneat of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in as alternate lirrntat, please contact the department at 6US-266-3151 or TTY 608.264-8777.
u
r'rooer:v Dwaei z: !`i~ I .C h _ I Fage a
G BUr Iny
y Ori^_; k
"-Pit Grounc surra_u eie. - i. Depli u: i,: niting tacsr - In- Soi. A^o.im;ion Rate
-tonzor Deptr Dam nan Coa- keacx Descripi ar Texture Structure Consistence bouneery Rao's GDD1ff
in. t~1ur: J 1 Lt.. Sc. Con:. CoiC. _ G- Sr..
- 5o'trtr
_I ai• Gra.: n:: su^a; i, elegy. Je:ah to milino ta:;c, in.
5011 Ac~.r::;auz Rate
r.~pr Ge;at. Dom.nent Corr ften~x s notur !>.zi..: SU.:a re :.;asislence-Tourcary Roos J:'c
i. Mursell G~. S „on'. GCLr - S.- Sr. ! -E`.fdt -Effr?
RCnn
"''''ng' GrOUn;i sur'a_r uic t•. DeClh IC itm:ling facto' ht.
Pit Soi', AOoiicat•Dn Rate
Deom Dominan: Color' R,-=x Descriptiol Texture Suucture Consistence boonoarv Roots GPD'ff
:r. hfunsel Cont. Color 1 Gr. Sz. Sh. Effw 'EHO
tfwcn: et = bOD > 36 < [7?::rn:t anG TSS %3: - t tnnt. clhuent 62 = bDD, 3: mg.-L anc TSS _ K mg4
aar:atcnI of Commeroc is an equal opportunity Sc7N'7CC p:ovioer and cmpioycr. If you need assistance to access sen ices or
aec.i material in an aitcmale ionnat• picase contact lire oenarnnent at 608-266.3151 or 'M 60fi-264-87'7.
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